Monday, February 24, 2014


You are called to a stroke code. A 50 year old man who was admitted to the hospital with a complicated UTI developed the neuro finding above. He has a past medical history of hypertension, arthritis, and BPH. He has no known neurologic history. He was admitted to the hospital with dysuria and found to have a resistant strain of Pseudomonas. He was started on ciprofloxacin and gentamicin. He normally takes metoprolol, but ran out a couple months ago and was restarted on this hospitalization. This morning, his magnesium was slightly low and was replaced. The rest of his labs are fine. This neurologic finding resolves later this afternoon.

Challenge: What's your diagnosis?

Image shown under GNU Free Documentation License.


Alex said...

um.. anything besides ptosis?

Craig Chen said...

Yep - it's ptosis, but uncovering an underlying condition

This is myasthenia gravis. Myasthenia gravis can be exacerbated by many medications including fluoroquinolones, aminoglycosides, beta blockers, and magnesium.

Sources: UpToDate; Wikipedia.